Making History

Good morning! Before we left Columbus for our meetings in NJ, I tried to make history. Let’s just say, it didn’t go well. I took careful notes that evening as I did not want to forget the day’s events. Here are my notes verbatim:This morning’s Tuesday’s clinic started like any other. It’s a sunny 74 degree day. It is shortly before 8:00 a.m., and as we were finishing preparation on our first patient, my nurse, Holly, shares a great idea. “Gosh, it’s beautiful out there. We should have clinic outside today! We are part of Walk with a Doc for goodness sakes!” Emphatically slamming their fists into the desk with big smiles, Diane, Rose and Loretta, the other nurses, laughingly agree. They subsequently walk with their doctor into their patient’s rooms. They must’ve been kidding. I wasn’t laughing. This is 2017 and this is the year to take action! “C’mon let’s go Holly” and we head into Nancy A. Lundquist’s room. “Oh Lordy,” she says. For HIPAA, let’s call her Jane Smith. “Jane, how would you like to have our office visit on the trail?” As I ask, it is rapidly occurring to me that this could be The First Walking Office Visit EVER. She looks at her husband with trepidation. He shares the same expression. When Jane looks back at me, I confidently share, “C’mon, no fuzz. It’s right outside our office.” “Well, I guess you’re the doctor.” Jane and Mike gather their pills, purses, jackets and books to follow us downstairs. If this moon shot attempt works, we’re heroes. If it fails, we had our 15 minutes in the sun – get it? Aside: We get asked a couple times a year if there is a way to code or bill for Walk with a Doc. Now we would try it and find out for ourselves (spoiler alert, we’ve talked to the decision makers and the answer is currently ‘no’). Holly was looking at me in disbelief as we make our way down the stairs, through the double glass doors and out into the gorgeous weather. The sun is so therapeutic. Our next patient is at 8:15 and I loathe tardiness. Crossing the vast parking lot and onto the bike path, Jane and I walk in front with Mike Lundquist and Holly equally spaced behind us. Had I thought this through enough? Would Holly be able to scribe and walk at the same time? Looking over my right shoulder to check on those very questions, I miss an important step and trip on the curb. Hitting the ground, I blurt out some terrible non-doctor words that I’m not proud of – at all. I can deal with horrific pain, but I feel terrible for another reason. As I was writhing around the hot blacktop screaming. I unintentionally roll up on Jane’s Achille’s. I take her, the patient I’m trying to help, to the ground. Fortunately, she lands on me and bounces up immediately. I’m still down and not getting better. Over the next minute or two, Jane and Mike generously help me up and we finish crossing the lot up onto the bike path. 8:06. It should be noted at this time that Holly had failed to bring gauze (why is that Holly’s responsibility?!) and the face is a highly vascularized area. That means the bleeding will often appear much worse that it is. That doesn’t make any sense? Well, nothing worth achieving is ever easy. At this point, we are safely on the bike path and we are about to have the First Walking Patient Visit EVER. “Jane, how have you been? Any chest pain? Any shortness of breath? (Jane had a drug eluting stent to her proximal LAD in June of 2012, but due to HIPAA we are unable to share that in an open setting like this.) Jane is having a hard time hearing me as many passing cars were honking and pointing at us. Apparently, no one in our town has ever seen 4 people having an office visit on the bike path…with the doctor’s face and left half of his white coat covered in blood. To be fair, at this point in the visit, the bleeding is pretty profuse. 8:14 The honking is starting to disrupt the flow of our conversation, so instinctively I pick up the pace. Jane, who will be 84 on June 23rd is having trouble keeping up. Fair enough. “Holly, could I please have the BP cuff?” Poor thing. She runs up and hands it to me. Have you ever tried to take someone’s blood pressure while walking at a fast clip? Believe me, it’s not easy. Wow, Nancy your blood pressure is 156/91 (120/80 is normal) and your heart rate is 121! (normal 60-100) That’s too high. “I’d like to see what yours is Dr. Sabgir,” she mutters under her breath. “Excuse me Nancy, what did you say?” “I said do you think it’s because we are walking…so…fast?” She’s having trouble catching her breath. “Holly” I shout backwards “Please send in a script for metoprolol 50 mg po bid for tachycardia” “No” Holly says. “Metoprolol? That’s stupid. By the way, couldn’t even if I wanted to – no Wi-Fi out here.” 8:19 Holly’s right. I do take a mental note that she appears a tad frustrated. The others going the opposite direction on the trail are undoubtedly trying to figure out what metoprolol is. I wonder if this is a HIPAA violation? (Do you think?!?!) Now it’s time for the physical exam. “Jane, could you please get in this paper robe” Unlike Holly I had remembered the necessities. “How are we going to do a thorough physical exam out here?!” Jane has a really good point. 83 years brings sage wisdom. The buzzing frequency in my right pocket has picked up (I’m supercareful about turning the ringer off when seeing patients). Now I have to be rude and take a look. The screen is indeed cracked, like I would later discover about my 7th and 8th ribs, but I’m fortunate that my iPhone appears to be operating perfectly. As I review the 11 texts from our medical assistants, practice manager, and front office team I’m initially confused. It looks like they are showing, yes, indeed they are showing a significantly increasing concern about our absence from a busy office. 8:27 I’m not sure that this Walking Visit suggested by Holly was a good idea. It’s blurry when I look at Mike and Jane hugging as Holly pats them on the back. I may have a slight concussion. Now one of the cars instead of honking, had pulled up beside us. Oh look, it’s Reva, my boss! 8:31 “Hey Reva!” She turns on her hazards and runs around to kindly comfort our patient and spouse. She helps them into her minivan. Holly is looking at me with a strong air of concern. I wonder if this visit will get me in … “David, please get in the car now.”